Saturday, 14 February 2015

Liverpool Care Pathway - Reports And Reports Of Reports

This is election year... and they are all so busily picking up pointers they are actually missing the point.

When a policy model is rolled out as a national programme its effects cannot be ultimately calculated but must become compounded and, like dominoes toppling, will effect unforeseen outcomes.

In this report in The Independent, they are busily picking up pointers for the pundits to raise as campaign issues.

The dominoes are toppling but the pennies haven’t dropped...

Health officials are investigating a “statistically significant, sustained” decline in life expectancy among elderly people in some parts of England, amid warnings that cuts to social care and pressures on the NHS may be contributing to earlier deaths.

Public Health England said it was scrutinising life expectancy trends following an alert from a council in the North-west of England warning it was “likely” that in many parts of the region “older people (over 85) are no longer living longer”.

Public Health England said it was scrutinising life expectancy trends following an alert from a council in the North-west of England warning it was “likely” that in many parts of the region “older people (over 85) are no longer living longer”.

An email from Blackburn with Darwen Council’s director of public health, Dominic Harrison, sent to regional colleagues and to Public Health England, said the council had seen a “sustained reduction” in life expectancy at 85 in its area. “Actual sustained cohort reductions in life expectancy such as this are now extremely unusual,” the email says.
They have foraged some windfalls for the hustings. The Independent headlines -
Fall in life expectancy raises alarm amid fears that cuts and pressure on NHS may be to blame for earlier deaths
But the devil is in the detail:
Dr John Middleton, vice-president of the Faculty of Public Health, said that a decline in life expectancy at any age was a matter of concern and should be investigated.

“We’ve enjoyed improvements in life expectancy over many years and there’s nothing to guarantee that improvement goes on forever,” he said. “It is something that is a sentinel moment in public health terms if the trend of upward improvement does stop.”
This is nothing new. Readers of these pages will have read this here before. What is going on?

A 'decline in life expectancy' is another way of saying excess deaths.

More excess deaths...

Excess deaths: again, the Kraken wakes.

It has been reported in these pages how newspapers and political interest groups will report the news to suit their own particular perspective.

Joining up the dots, they conclude cuts but you have to join all the dots.

1,400 excess deaths at Mid Staffs...

1,600 excess deaths at Basildon and Thurrock...

United Lincolnshire plus The Dudley Group plus George Eliot plus Northern Lincolnshire and Goole plus Tameside plus Sherwood Forest plus Colchester plus Medway plus Burton plus North Cumbria plus East Lancashire plus Buckinghamshire Healthcare equals 13,000 excess deaths since 2005...

Nobody held to account, nobody disciplined...

The BBC reported –


130,000 LCP deaths a year...

How many of those 130,000 would have lived on to make up the missing numbers?

"Excess deaths". Mostly, they don't bother to do the paperwork on the LCP. Trusts have admitted they have no information. If they did the paperwork, or just did it properly, they would know. They don't know.

How many of those "excess deaths" are down to implementing the LCP?

The kissing has to stop. You can’t all continue to treat this as a political football to kick around. You can’t all keep batting back the ping-pong ball; it’s not a game you’re playing. You have enacted policies and they are taking effect. It’s as simple as that and the killing has to stop.
The New Statesman –

What does this graph tell us? It tells us that the EoLC Programme has worked; the EoLC Strategy is working; and that, for the first time since Mr. Patrick Gordon Walker’s landmark speech, the demographics are going in the ‘right’ direction.
The number of older adults is increasing 
• The absolute number of older adults and their proportion in the population is significantly increasing. From 1983–2008, the proportion of the total population aged 75 years and over in England increased by a third from 6% (2.9 million people) to 8% (4.0 million people). The population aged 75 and over is projected to increase to 7.2 million in 2033, and the number of people aged 90 and over is projected to increase from 0.4 million in 2008 to 1.2 million in 2033.(Office for National Statistics).
• Increases in the ‘oldest’ population have resulted from falling mortality rates in the second half of the 20th Century and increased birth rates at the beginning of the 20th Century (Dini & Goldring, 2008). In the UK, from 1968–2008 mortality rates declined by 51% in males and 43% in females (Office for National Statistics, 2009).
• In England, life expectancy (period expectation of life at birth) increased by over 6 years in males from 1980–82 to 2006–08, from 71.1 years to 77.7 years, and by over 4 years in females, from 77.0 years to 81.9 years (Office for National Statistics) 
National End of Life Care Intelligence Network
Mr. Patrick Gordon Walker’s landmark observations echo down the years.

There are always consequences. A programme or strategy promoted and rolled out by government will multiply those consequences. There have been "excess deaths". There are "missing" older adults. Where are those missing ninety year-olds?

Mail Online has reported a ten-fold rise in palliative care deaths –

Mail Online, citing Doc Foster, sees this as massaging the figures on the sly. It suits their editorial stance and all that LCP business has dropped out of the picture and is no longer, perhaps, newsworthy.

This is Dr Foster -
The report highlights Dr Foster’s concerns that current palliative coding encompasses a wide variety of palliative pathways. Patients admitted to hospital specifically for specialist palliative care cannot currently be distinguished from those who were admitted for treatment and whose subsequent deterioration in health led to them receiving palliative care.
Roger Taylor, of Dr Foster, explains how an elderly patient might go in to hospital with a broken hip, develop an infection and die...

Actually, Mr.Taylor, this is precisely what does happen and has been happening.

It could be a broken hip, it could be anything. Curious you should say a broken hip, though...

This is Chad -
Graham Bennett’s mum Gladys was admitted to hospital in October 2010 after falling and breaking her hip at her home at Burton Court in Bilsthorpe.
But she died later that month at King’s Mill after Graham was asked to sign forms that he now believes gave consent to put her on the Liverpool Care Pathway (LCP).
“It was never mentioned, that’s what annoys me,” said Graham (70).
“It’s taken a time to come to terms with it, even though my mum 
Downsize care by downsizing care expectations. Initiate a programme of ‘identifying’ the One Percent who statistically die via a protocol of assessment involving statistical probability and intuitive judgement and earmark them for EoLC.

This will (of course!) trawl in many who would not have formed part of that One Percent cohort. By far the greater part of medical error consists of medical misdiagnosis. There will be excess deaths...

The Route to Success documents are available here.

The route to success in end of life care - achieving quality in ambulance services28 February 2012 - National End of Life Care Programme
This guide sets out the key role and contribution of ambulance services in achieving high quality care at each step along the end of life care pathway.

Whilst highlighting the crucial role of ambulance services, the guide also acknowledges the unique set of challenges and barriers that need to be addressed and overcome. 
Good practice examples and top tips are provided throughout to make this guide a key tool not only for ambulance services, but also for other health and social care providers, professionals, managers and commissioners.
Order hard copies by email to:

The "unique set of challenges and barriers" makes pertinent reading here -
Liverpool Care Pathway - On The Final Stretch
The June 2010 Macmillan End of Life Care Newsletter shares the National End of Life Care Programme logo and is published by NHS.

From the Newsletter - "Discuss with family and friends how to get care and help at different times. Specifically advise that calling 999 is very seldom appropriate and may result in resuscitation, transfer and admission."

Everywhere, in regard to healthcare, you will hear this mantra -
Affordable, Sustainable.

Target-based CQUINS were set...

This is the End of Life Baseline Report -
End of life care is a key priority of the North West regional QIPP workstream for Demand and Threshold Management and the North West SHA in recognition that improving QIPP across the end of life care pathway will significantly support overall delivery against the £20 billion QIPP challenge by 2014/15. 
"Excess deaths" continue to be the indicator that something has happened, is happening.

The Review has slammed the use of the LCP, but still reserves some good thoughts for the LCP itself. There are other ‘last days’ pathways, though, and these are all still up and running.

As mentioned in these pages, the Welsh Collaborative Care Pathway, for instance, had a 'fundamental rewrite' and was relaunched­­­ because of 'adverse publicity'. Now, the same is happening to the LCP? These should not be looked to to replace the LCP; rather, they should be subjected to scrutiny and review themselves.

Additional reading -
Liverpool Care Pathway - Missing The Plot

Liverpool Care Pathway - When The Caring Had To Stop

Liverpool Care Pathway - The Palliative Option

Liverpool Care Pathway - What Is To Be Done...?

Liverpool Care Pathway - So What's The News?

Liverpool Care Pathway - Time To Wise Up

Liverpool Care Pathway - From “Nightingale To Nightmare”

Liverpool Care Pathway - Ten Years In The Waiting
Liverpool Care Pathway – Excess Deaths

Liverpool Care Pathway - The King Lives!

Liverpool Care Pathway - All Change!

It is determined by the physician's subjective perception of a life considered worthy of life and of a life not so adjudged worthy of life. It is to do with health care rationing and the intrusion of the Communitarian ethos into the mainstream.

It is doctors abandoning traditional ethics.

It was once unthinkable to permit an action that would cause or permit death. Today, doctors don death caps and sit in judgement of their patients worthiness to live. The right to life, the right to live, has been submerged beneath a tidal wave that demands the right to die.

For years, the British public has been softened up to accept dying as a positive life option.

The Government published its NHS National End of Life Care Program in 2008.

The NCPC has been running the EoLC programme since 2009. They have downsized care expectations.

A system has been rolled out. It is in place.

A system has been rolled out. It is working.

Excess deaths...?

Excess deaths!

The project continues, and there are reports and reports of reports.

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